Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 13817 | Date 03/12/2025 |
| Token No | SM/25-26/2856 03/12/2025 | Serial | 005 |
| Patient Name | Mrs. LALITA DEBI | Contact No | 9748122186 |
| Address | 6 NO LINE RAM SITA LANE | Age | 35 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||